Health Svcs Associate - PCHP

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Parkland Community Health Plan’s (PCHP’s) Health Services Associate is responsible for supporting the Health Services Department by providing support for case management, clinical appeals, discharge planning, disease management, population health, behavioral health, and utilization review processes.  Review documents for accuracy, expedite general workflows, assist in member intakes, communications, and scheduling of follow-ups.

Minimum Specifications

Education

• Bachelor’s degree is required.
• Degree in a health-related field is preferred.

Experience

• 3 years of experience in customer engagement or customer service.
• Experience in Insurance, Managed Care, or Health Care is highly preferred.

Equivalent Education and/or Experience

• May have an equivalent combination of education and experience to substitute for the education or experience requirements.

Certification/Registration/Licensure

• Community Health Workers (CHW) certification is preferred.
• Medical Assistant certification is preferred.

Required Tests for Placement

• Must pass the Customer Service test with a minimum score of 75%.

Skills or Special Abilities

• Clear and professional verbal and written communication skills.
• Practiced with accurate spelling and good grammar.
• Flexible and well organized.
• Able to prioritize and multi-task.
• Able to read and utilize reports and tracking tools.
• Ability to use basic problem-solving skills.
• Proficient with office machines (i.e., copier, fax, telephone), and personal computer.
• Knowledge of relevant software applications including Microsoft Office, email, and internet.
• Good numeracy skills.
• Accurate keyboard skills.
• Familiar with medical and managed care terminology is preferred.
• Bi-lingual in English and Spanish is preferred.

Responsibilities

• Manages correspondence with providers, specialists, members, and health plan staff.
• Secures member demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations.
• Receives inbound and outbound calls to members, providers, and all other inquiries.
• Interviews members to determine how they can be assisted in receiving services and procedures.
• Performs administrative task such as creating member records, maintaining case files, updating referral information, verifying information related to benefits ensuring that the information is properly updated.
• Reviews accuracy and completeness of information requested and ensure that all supporting documents are present.
• Follows NCQA standards, health plan UM, appeals and case management policies.
• Works cooperatively with all staff in expediting the general flow of matters pertaining to the case.
• Participates in self-audits and peer reviews to ensure compliance with regulations, standards, and departmental policies.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.